203: Licorice + Topical Steroid Exposure - Should You Be Concerned? (PART 1) w/ Dr. Carrie Jones

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There has been a lot of controversy recently about licorice root and using it in people who have had excessive exposure to steroids. It's my hope that my guest today will clear up some misconceptions.

This conversation isn't meant to tell you whether or not licorice (and other adaptogenic herbs) are appropriate for you. Instead, we're sharing some science behind things so you can make a more educated decision.

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

My guest today is Dr. Carrie Jones, an internationally recognized speaker, consultant, and educator on the topic of women’s health and hormones.

Dr. Carrie graduated from the National University of Natural Medicine (NUNM), School of Naturopathic Medicine in Portland, Oregon where she also completed her 2-year residency in women’s health, hormones and endocrinology.

Later, she graduated from Grand Canyon University’s Master of Public Health program with a goal of doing more international education. She was adjunct faculty for many years teaching gynecology and advanced endocrinology/fertility and has been the Medical Director for 2 large integrative clinics in Portland.

Dr. Carrie is the Medical Director for Precision Analytical, Inc, creators of the DUTCH hormone test.

Join us as we talk about licorice and topical steroids.

Have you been concerned about licorice? Tell me about it in the comments!

CHECK OUT PART 2 of this conversation HERE

In this episode:

  • What are corticosteroids?
  • What is cortisone?
  • What are mineralocorticoids?
  • What is licorice root?
  • What is a cortisol pattern supposed to look like?
  • What is the 11β-Hydroxysteroid dehydrogenase enzyme (11b-HSD)?
  • Why people going through Topical Steroid Withdrawal (TSW) are wary of using licorice root
  • Is licorice a steroid?
  • Could licorice root be helpful, and what are generally considered safe dosages?

Quotes

“We have steroid hormones, steroid hormones come from cholesterol. So, that's your cortisol, that's your testosterone, that's your estrogen, estradiol, estrogen, progesterone.” [0:56]

“Giving licorice is not the same as giving cortisol. It's not a bio-identical for cortisol.” [16:31]

Links

Find Dr. Carrie online

Adrenal Insufficiency in Corticosteroid Use: A Systemic Review and Meta Analysis

Use coupon healthyskin50 for $50 off a DUTCH Complete or DUTCH Plus test

Healthy Skin Show ep. 072 Sex Hormone-Skin Rash Connection w/ Dr. Carrie Jones

Healthy Skin Show ep. 153: Steroids + Cortisol: How To Pinpoint Adrenal Problems w/ Dr. Carrie Jones

Follow Dr. Carrie on Instagram

Licorice + Topical Steroid Exposure — Should You Be Concerned? (PART 1) w/ Dr. Carrie Jones FULL TRANSCRIPT

Jennifer: Dr. Jones, thank you so much for being back here on the show. I know this is going to be a hot topic but you always deliver, so I appreciate your presence today.

Dr. Jones: Oh my gosh. Okay. First of all, we're friends. So call me Carrie. You know I'm informal.

Jennifer: I know.

Dr. Jones: Even though it's the podcast, you don't have to refer to me as Dr. Jones, but thank you for having me back. You know I love to talk about this.

Jennifer: I know. So today we're going to be talking a lot about well, our adrenals and a whole bunch of other things associated with them. So since this is a lengthy conversation, and it's going to involve a lot of terms that people may or may not be familiar with, let's start off laying some groundwork. So everybody who's curious about licorice root and TSW and stuff just stay tuned, but we got to lay the groundwork first. So Carrie, what are corticosteroids? What are they? What do they do?

Dr. Jones: So let's even go up a level just so people realize we have steroid hormones, steroid hormones come from cholesterol. So, that's your cortisol, that's your testosterone, that's your estrogen, estradiol, estrogen, progesterone. So we talk about steroid hormones. When you hear people say, “I'm going to test my steroid hormones.” You may confuse them and think no, that's like steroids I took steroid cream that's bad, but really in the body you do make steroid hormones and obviously they're very important. Then we specifically talk about cortisol. Cortisol is a glucocorticosteroid. So it's a very specific branch of the steroid family. Cortico because it comes from the cortex of the adrenal glands.

Dr. Jones: So it's a location part of its name gluco, because that's what its number one job is. If cortisol had a resume it's top skillset is I help you manage your glucose, which a lot of people don't realize. Obviously, glucose is affected by a lot of things and cortisol affects a lot of things inflammation, infection, what have you, energy. Glucose is the number one thing cortisol goes after. So glucocorticosteroid is a glucose managing hormone from the cortex of the adrenal gland under the umbrella of steroid hormone that is cortisol and you make it naturally.

Jennifer: And what is cortisone? Until I really dove into even the testing side of things, I was just like, “Cortisol, cortisol.” And then I slowly realized, I was like, “It's not just cortisol.”

Dr. Jones: Cortisone is the inactive form of cortisol. Now people get this confused a lot because they're thinking, I use hydrocortisone cream is that the same thing? No, it's a terrible naming thing by pharmaceutical companies. Hydro, when you put the hydro in front of it, hydrocortisone is really cortisol, but they don't call it cortisol cream they call it hydrocortisone cream, cortisone in your body is inactive. So when cortisol is doing its job and the body's like, “Okay, thank you very much. That's enough.” We have little enzymes that turn it off like a switch. And when it turns off, it flips into cortisone. Cortisone is dead in the water. It doesn't do anything it doesn't activate anything, but then the body can reactivate, it could flip the switch back on again like a little light and it will flip back into cortisol.

Jennifer: And we'll talk more about that in a little bit.

Dr. Jones: Yes.

Jennifer: So I've also read some concern from people just about the mineralocorticoids. What are those in comparison?

Dr. Jones: Yeah. So they have a lot to do with your salt water balance. So your aldosterone with an A, aldosterone also comes out of your adrenal glands, just a different layer, and it binds to your mineralocorticoids receptors and helps you with salt water balance. The problem is cortisol can also bind to those same receptors. Cortisol has its own receptors. It has its own home called glucocortico receptors, but cortisol can be like real nosy and go in its neighbor's home, which is the mineralocorticoid receptors, and bind to it and affect it as well. Which is why when people have a lot of cortisol sometimes they say, “I have a problem with my salt water balance I'm puffy, I'm swollen, I retain water.” Because cortisol's going to the neighbor's house as opposed to staying in its own house.

Jennifer: I love your analogies they are so great. And then the last thing I want to define here is… Well, not define, but let's talk a little bit about licorice root because everybody knows where this conversation is going. There's a lot of controversy around licorice root and using it for people who've had excessive… And I'm going to say excessive can mean different things for different people because we don't know what excessive is for any particular person, but an excessive exposure to steroids, whether they're topical or… You and I talked about this, you can have reactions to different forms of steroid exposure. And so what is licorice root in terms of it being like a botanical or herbal supplement so to speak?

Dr. Jones: Yeah. So licorice has the… One of the big active ingredients in it as glycyrrhiza, and licorice that glycyrrhiza, it helps to keep cortisol active and delay its breakdown. And so it keeps it hanging around your body longer. And so if you are a deactivator, so you're a person who tends to deactivate to cortisone, it will stop that it will help you keep cortisol around longer. And if you're a “breakerdowner” then it will stop that or slow it down, I should say. It'll help keep your cortisol floating around the body a lot longer. And licorice root is been used traditionally obviously for so many years in the herbal plant medicinal world, way longer than you and I have been alive and a lot of… Hundreds and hundreds of years, and herbalists often call licorice a great harmonizer.

Dr. Jones: So you will often see a tiny bit of licorice in teas, even in teas that are supposed to be sleepy time teas or you'll find them in immune support or you'll find it in adrenal support or stress support because as several master herbalists I've studied from said, “Licorice just helps other plants play well together.” It's just a really nice harmonizer, but you can go to the other end of the spectrum. You can take hundreds of milligrams, which is a lot, to really knock the cortisol system over the head and make sure you keep cortisol around in your body longer.

Dr. Jones: Licorice will get into you but it's not without its risks you have to be careful. It can raise blood pressure because cortisol can raise blood pressure and it can deplete potassium. Meaning you'll lose more potassium than you want to and now your potassium deficient, which could land you in the hospital. So you have to keep an eye on that. But it is dose-dependent and is length-of-time-dependent, like taking a sleepy time tea with a tiny bit of licorice it's probably not going to affect your potassium.

Jennifer: All right. So let's set the stage here. So in terms of a DUTCH test, which is such a great visual for… We get to see on the cortisol awakening response especially, that one panel where you'll see the line for cortisol and you'll also see the line for cortisone and then you'll get a chance to see what do you shift more or less to? And so in someone who has this really… Their body essentially became addicted to having that hydrocortisone exposure what does the pattern… Well, I guess let's say, what is the pattern normally supposed to look like? And what does it look like in somebody who ends up in this particular state where their body really is seeking out essentially that exogenous form of cortisol?

Dr. Jones: So as we know, when you take steroid hormone like prednisone as an example, or maybe you take fluticasone or you take a steroid inhaler, that steroid is way more potent than cortisol. It doesn't look like your cortisol, but it's close enough. So what it does is it goes back to the brain and says, “Wow, you have a boatload of kind of cortisol going around binding to receptors.” So the brain goes, “Cool, I'm not going to tell the adrenal glands to make cortisol because it seems like you've got it under control with this whatever inhaler, nasal spray injection, topical, whatever you've got going on as a steroid.” And so your own production of cortisol goes down and you're just supplementing with whatever medication you're doing. So then when you go to test what you find is exactly what you just said.

Dr. Jones: When you go to test you will see really low levels of your own cortisol. Your own cortisol goes way down. And so what people then try to do is try to figure out how do I get my cortisol back up again? How do I get my adrenal glands back online again? How do I get that whole brain-to-adrenal connection happening? Unfortunately, as we know exogenous steroids, meaning the cream, the nasal spray, the injection, what have you, they're potent, they're really potent.

Dr. Jones: And it can be really hard to work against if you're actively on them. But if you have been weaning yourself off of them and you were trying to wean yourself off of let's say, topical steroid cream or prednisone, while you're trying to get your HPA back working again, that's when we can use things like we mentioned earlier, that's when you can use things like licorice, you can use things like adaptogens to help your body sync back up and start to get its own cortisol factory going again.

Jennifer: So with this pattern normally, we'd see cortisol spike in the morning and then slowly throughout the afternoon to the night time it'll come down. But in, and I've seen those same clients who have topical steroid withdrawal and are dealing with that, it's really pretty flat.

Dr. Jones: It's very flat because again, that signal goes up to the brain and says, “Well, he or she, they're doing it topically so you don't need to make any.” And the brain's like, “Cool, got it. No problem I'll…” And so your own cortisol just goes way down and flat lines.

Jennifer: What happens with the cortisone then?

Dr. Jones: It depends on the person. So some people, we have these two enzymes that activate or deactivate cortisol. And so some people will… And especially initially when their cortisol is going down, their own body cortisol, that enzyme becomes really active and is trying to keep as much cortisol around as possible. And other people deactivate, other people go the other way and so they actually form a lot more cortisone trying to deactivate everything, all the exogenous stuff that's coming in as fast as possible. And you can be depending on how long you've been on the topical steroid, like length of time, dose you're on.

Dr. Jones: I don't have a prediction. I can't tell you like, “Well, at five weeks or less.” It doesn't work like that since everybody is different in what's going on. And that's why testing is really helpful. I am not on topical steroid cream or any kind of steroid cream, but I am a deactivator. I had my own labs run in the March timeframe and I'm a massive deactivator so my cortisone, my personal cortisone is much higher than my cortisol.

Jennifer: Well, I want to talk about that enzyme. So just to give everybody a sense of how I even came about this I do have clients that want to do a DUTCH test, which is a really great urine test. You pee on a strip, let it dry and you mail it back to DUTCH. And then you guys are just like, “Hey, great. We're going to measure all these different metabolites in it.” And what was fascinating was I was on a console with one of your doctors. And he had suggested that a client might want to consider adding in a little bit of licorice root. And I was like, “Oh no, no, no, can't do that.” Because unfortunately, this person has this and they're going through TSW and they're really concerned. And they're very vehemently against using licorice root.

Jennifer: They've already made me very clear of that because they don't want to be on any type of steroid. And I'm just literally saying to the doctor what this person has said to me, and he's like, “That's not how that works.” And I was like, “Okay, can you explain this to me so that I can explain this to my client?” And so that's where he told me about the 11β-Hydroxysteroid dehydrogenase. And we'll just call it 11β-HSD for short everybody, this is an enzyme in your body. And so let's talk about what it is and what it does.

Dr. Jones: You have type one and you have type two. So you will read about if you are Googling this right now, it's 11β-HSD one or 11β-HSD two, so 11β-HSD one activates. It turns cortisone into cortisol, turns everything on turns cortisol on, 11β-HSD two does the opposite it deactivates, it converts cortisol into cortisone. And you have concentrations of these enzymes in various places. So for example in your kidneys, in your saliva glands, anywhere you have sweat glands, some of the intestines, you will have a lot more deactivation because your body is trying to protect you. So specifically, like in the kidneys, our kidneys regulate our blood pressure. And so if we have a lot of cortisol slamming into the kidneys and binding to the glucocorticoid receptors and binding to the mineralocorticoid receptors, then we are more prone to blood pressure issues, high blood pressure.

Dr. Jones: So the kidneys are like, “Uh-uh (negative), I'm going to turn you off.” And it deactivates it into cortisone to protect itself as an example. Other tissues have the opposite, like fat tissue, unfortunately has a lot of activation. You activate a lot of cortisol in your fat tissue which is part of that cyclical problem is that when you have stress you get the belly fat, you have the belly fat, you get more cortisol and you feel more stressed out or have other issues, which is so unfortunate.

Dr. Jones: And so this enzyme, it's going and forth the different parts of your body all day long 24/7, protecting you, deactivating you, activating you. When you got an infection, you better believe everything's all systems go. You're reactivating, put the cortisol up let's help you when you're massively stressed out, you're not taking care of yourself, you've recently been sick, it's the opposite. Deactivate, sit down, rest, relax, self care. The body's trying to protect you.

Jennifer: So here's the thing where I think the waters get muddy and unclear for everyone who doesn't know what to do. So, as I said, with my client, she was afraid because of all the things that she's read online on blogs that licorice root is basically a steroid and became very afraid of that. I'm in groups and searching the term licorice brings up a lot of the same responses. Licorice is a steroid avoid it at all cost, is there truth to that?

Dr. Jones: So if you're a steroid, then you would have to be able to act like cortisol. You'd have to be able to be cortisol and bind glucocorticoid receptors, or be like prednisone, or be like fluticasone, or be like whatever zone you happen to be on that's causing you the steroid issues. Licorice activates enzymes, so it's an enzyme activator. It's not actually cortisol it's an enzyme activator. So it helps you have more cortisol and slows the breakdown of cortisol, but it doesn't actually replace cortisol. Giving licorice is not the same as giving cortisol. It's not a bio-identical for cortisol. It's not a lookalike… that's not how it works.

Jennifer: And so with that being said and if we go back to that HSD two, so the number two that goes from cortisol and turns it off, basically, I almost think of it as like soccer players on the field. Like you're an active player of your cortisol and if your benched you are cortisone, and you can flip back and forth whatever you want. But what would it be necessarily a bad thing if you have cortisone in your system but you don't necessarily have enough cortisol due to everything, and this imbalance within the HPX? Wouldn't it be helpful to at least deactivate or say like, “Let's keep with the cortisol, let's try and manage and stick with as much as we can.”

Dr. Jones: So I get this question a lot. I'm a prime example. My free cortisol is lower. It's not flatline, but it's low. And my cortisone is higher. So I had a lot of people say to me, why don't you take licorice? Did you take licorice? Did you just take licorice to activate and give yourself the ability to make and to have more cortisol? And my personal case me as an N of one, I didn't, because it was a straight up bandaid. I knew why my cortisol was low. Mine was not because of steroid withdrawal mine was because of burnout.

Dr. Jones: And because I wasn't listening to myself because I was pushing myself, I wasn't sleeping well. I'd worked really hard in 2020, and didn't take a lot of downtime and I essentially did it to myself. So if I were to just say in my particular case, I'm going to take licorice and get cortisol so I have more energy, but didn't change any of my habits or my mindset, it can only last so long.

Dr. Jones: Licorice is great, but it's not going to prop up a burnt out person who still continues to burn the candle at both ends. Now, somebody else is a different story completely. Let's say you are going through topical steroid withdrawal. You do have the flat line of cortisol. You're completely exhausted. You are more prone to inflammation because your cortisol is low.

Dr. Jones: You're more prone to glucose problems because your cortisol is low. As you're going through the weaning down process, and you have this flat cortisol, you may be a good candidate for licorice. You may be a good candidate because you have low cortisol. And we're trying to get it to turn back on. We're trying to get the whole system, your brain to tell your adrenals let's make cortisol. Let's activate.

Jennifer: Yeah, I think part of the tricky thing here is a lot of times there is no step down with topical steroids. A lot of times people will recognize something's really wrong here. This is not eczema or psoriasis, this is something else and they stop the steroids entirely. And I totally understand, I completely understand everybody's journey is different. So in the case where you just totally pull the plug on that external cortisol all of a sudden, is that possibly an instance where you could consider licorice root?

Dr. Jones: Yeah. It is helpful to test first don't just randomly… Like I said, licorice can, does activate cortisol, slows the breakdown of it, and unfortunately can affect blood pressure and potassium depending on your dose, depending on how long. So if you're going to actually seek out a supplement with a lot of milligrams, just be careful, maybe you should test first, but yes, that is an instance. If you have stopped your steroid cream and you are right immediately into topical steroid withdrawal, doing a little bit of licorice is probably going to help.

Dr. Jones: Again, people go, “Well, how much is a little bit Carrie?” Well, it depends. So in a lot of adrenal supplements, the mixtures, it's generally under a hundred milligrams. It's generally like 25 milligrams of licorice, 30 milligrams, 50 milligrams. But you can obviously find it much higher and you can find it in teas.

Dr. Jones: Obviously, you can find licorice tea which of course is low dose as well. And so that, we generally consider it… My patients that had this I was like, “Okay, it's pretty good, pretty safe.” What does concern me is there are companies that make 600 milligram doses and people go on that and they go on it for an extended period of time not realizing, because they can buy it at whole foods or Amazon. And all of a sudden they're like, “My heart is racing and I'm having all these problems. And I don't know what I did to myself.” I'm like, “That 600 milligrams is a lot.”

Jennifer: That is a lot.

Click HERE for Part 2 of this conversation!

REFERENCES

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498851/
  2. https://pubmed.ncbi.nlm.nih.gov/8504732/
  3. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0049976
  4. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/liquorice
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168306/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255378/
  7. https://www.medicinenet.com/corticosteroids-oral/article.htm

“We have steroid hormones, steroid hormones come from cholesterol. So, that's your cortisol, that's your testosterone, that's your estrogen, estradiol, estrogen, progesterone.”